Do your eyelids feel itchy?

(0)     None:                My eyelids do not feel itchy.

(1)     Mild:                  Once in a while, my eyelids feel slightly itchy, but I do not have a desire to rub them.

(2)     Moderate:         Occasionally, my eyelids feel itchy, and I need to rub them.

(3)     Severe:             It is difficult to relieve the sensation of itchiness even when I rub my eyelids.

(4)     Very severe:     I have unbearable eyelid itching with an irresistible urge to rub my eyelids.

Foreign body sensation/sandiness, grittiness

Do you feel like there’s something sandy or gritty in your eye?

(0)     None:                My eyes do not feel sandy or gritty.

(1)     Mild:                  I am aware of the surface of my eyes once in a while.

(2)     Moderate:         My eyes feel like there is something small in them occasionally.

(3)     Severe:             My eyes feel like there is something large or gritty in them.

(4)     Very severe:     I am unable to open my eyes due to feeling of a foreign body in my eyes.

Ocular dryness

Are your eyes feeling dry?

(0)     None:                My eyes do not feel dry.

(1)     Mild:                  I am aware of dryness to the point where I have to blink to feel better

(2)     Moderate:         I am aware of dryness to the point where I desire to use artificial tears occasionally.

(3)     Severe:             I am aware of dryness to the point where I desire to use artificial tears frequently.

(4)     Very severe:     I am aware of dryness, to the point where I always desire to use artificial tears.

Ocular burning or pain

Are your eyes burning or painful?

(0)     None:                My eyes do not burn or ache.

(1)     Mild:                  I am aware of the surface of my eyes; they mildly burn or ache.

(2)     Moderate:         I feel my eyes are burning, but still tolerable

(3)     Severe:             My eyes feel throbbing or fiery due to burning/pain.

(4)     Very severe:     I am unable to open my eyes due to burning/pain.

Swollen/heavy eyelids

Do you feel like your eyelids are heavy or swollen?

(0)     Normal:             I don’t feel that my eyelids are heavy/swollen.

(1)     Mild:                  I feel that my eyelids are mildly heavy/swollen.

(2)     Moderate:         I feel my eyelids are heavy/swollen, but I can tolerate it.

(3)     Severe:             I feel my eyelids are heavy/swollen, I like to close my eyes for a few minutes.

(4)     Very severe:     I feel my eyelids are heavy/swollen and have to make an effort to keep my eyes open.